Provider Demographics
NPI:1013351188
Name:BROOKLYN CHEMIST LLC
Entity Type:Organization
Organization Name:BROOKLYN CHEMIST LLC
Other - Org Name:EBF RX LLC DBA BROOKLY CHEMISTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-661-4279
Mailing Address - Street 1:2927 AVENUE S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3231
Mailing Address - Country:US
Mailing Address - Phone:718-382-3400
Mailing Address - Fax:718-382-3401
Practice Address - Street 1:2927 AVENUE S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3231
Practice Address - Country:US
Practice Address - Phone:718-382-3400
Practice Address - Fax:718-382-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317563336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031756OtherPHARMACY
NY031756OtherPHARMACY